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4/21/2016
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marcumllp.com
HOSPICE CODING WHAT NOW
IAHHC 2016 Annual Meeting
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Your Speaker
Bonny Kohr, RN, CHCE, HCS‐D
AHIMA approved ICD‐10 trainer
Senior Manager
Marcum LLP
111 S. Pfingsten Road, Suite 300
Deerfield, IL 60015
Direct: (847) 282‐6511
Marcum is a top national accounting and advisory services firm with 1500 professionals and 29
offices in major business markets throughout the U.S., Grand Cayman and China.
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Excerpt FY2016 Final Rule
“based on the numerous comments received in previous rulemaking, and anecdotal reports from hospices, hospice beneficiaries, and non‐hospice providers discussed above, we are concerned that hospices may not be conducting a comprehensive assessment nor updating the plan of care as articulated by the CoPs to recognize the conditions that affect an individual’s terminal prognosis.”
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Medicare Hospice Coding Requirements
Medicare Program; FY 2016 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements – Final rule Included clarification related to diagnosis reporting on hospice claims effective October 1, 2015 Hospices must report all diagnoses on the hospice claim based on current coding guidelinesHospices must report all diagnoses identified in the initial and comprehensive assessments, whether related or not to the terminal prognosis (including mental health disorders and conditions that would affect the plan of care)
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Coding Requirements
Health Insurance Portability and Accountability Act (HIPAA) requires providers to adhere to the ICD‐10‐CM Official Guidelines for Coding and Reporting when assigning ICD‐10‐CM diagnosis codesJune 5, 2008 Hospice Conditions of Participation final rule stated that the hospice must report all related diagnoses in addition to the primary terminal condition
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Coding Requirement Compliance
2010 over 77 percent of hospice claims continued to include only one diagnosisFY 2013 Hospice wage index notice instructed hospices to report all coexisting diagnoses “related to the terminal illness” (coding guidelines required the reporting of all diagnoses that affect the patient) Additional hospice rules continued to discuss the requirements and importance for diagnosis reporting
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Coding Requirement Compliance
2014 ‐ 49 percent of hospice claims continued to report only one code CMS analysis of the claims found 50 percent of these patients had, on average, eight or more chronic conditions 75 percent had, on average, five or more chronic conditions
ICD‐10‐CM PRINCIPAL (Primary) DIAGNOSIS
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Definition of Principal (Primary) Diagnosis
The principal diagnosis is defined in the Uniform Hospital Discharge Data Set (UHDDS) as “that condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care” In the case of selection of a principal diagnosis for hospice care, this would mean the diagnosis most contributory to the terminal prognosis of the individual
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Trends in Hospice Principal Diagnoses
Increase in neurologically‐based diagnoses from 2002‐2007 Various dementia diagnoses Increase in use of non‐specific, symptom‐classified diagnoses (debility and adult failure to thrive)
By 2007 debility was the first and adult failure to thrive diagnoses was the sixth most common principal diagnoses
During this same period hospice spending increased partly due to an increased length of stay 2000 the average lifetime length of stay was 54 days 2013 the average lifetime length of stay was 98.5 days – a 82% increase
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Diagnoses Which May Not Be Principal
Edits for Hospice diagnosesOctober 2014 debility and adult failure to thrive as a principal diagnosis were returned to providerClaim edits were also implemented to eliminate submission of claims were the ICD‐9‐CM (now ICD‐10‐CM) codes were not permitted as a principal diagnosis according to coding guidelines
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Top 10 Principal Diagnoses
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Top 10 Principal Diagnoses
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Diagnoses and Medicare Payment
All services related to the principal diagnosis must be provided by the hospiceMedicare payment may be made outside the hospice benefit for conditions that are unrelated to the terminal illness and related conditions (that is, unrelated to the terminal prognosis) Professional claims with GW modifier Institutional claims with 07 condition code Prescription drug events (PDEs) do not require a modifier or condition code Part D plan sponsors have prior authorization requirements on four classes of drugs (analgesics, antinauseants, laxatives and antianxiety)
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Concurrent Payments for DME during Hospice Stay, CY2013
Concurrent Payments for Part D drugs potentially related to Hospice Stay, Top Four Principal Diagnoses CY2013
Cerebral Degeneration
•$10.3 million
COPD
•$8.6 million
Congestive Heart Failure
•$3.8 million
Malignant Neoplasm, Trachea, Bronchus and
Lung
•$2.1 million
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CMS Concurrent Payment Case Study CHF as Principal Diagnosis
“Services that are potentially related to this condition”$3.8 million in drugs
$1.2 million in Part B institutional settings $843,534 in DME
CMS Concurrent Payment Case Study CHF as Principal Diagnosis
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Other Diagnoses Definition
All conditions that coexist at the time of admission, that develop subsequently, or that affect the treatment received and/or the length of stayAll diagnoses affecting the management and treatment of the individual within the healthcare setting are required to be reported
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Diagnoses:Impact on Certification, NOE, Care Plan and Payment
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Principal Diagnosis and the CTI
To reach a decision of terminal illness the medical director (in consult with the attending) must consider The diagnosis of the terminal condition (not the diagnosis code)Other health conditions/diagnoses Clinically relevant information supporting the diagnoses The physician is not required to provide diagnoses code(s)
Avoid principal diagnoses which contradict the CTIAvoid diagnoses which do not support the terminal condition
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Principal Diagnosis and the NOE
The NOE must contain HIPAA approved codes Full diagnoses codes including all applicable digits The principal diagnosis listed is the condition most contributory to the terminal prognosisDo not report principal diagnosis codes that are non‐reportable – they will be returned to the provider (RTP) Z codes Unspecified codes Diagnosis codes prohibited by ICD‐10‐CM coding guidelines and conventions as principal diagnosis
See attachment: Hospice Invalid Principal Diagnosis
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Other Diagnosis
Help to support the terminal prognosis Include all conditions which may impact the palliative care of the patient’s terminal condition
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Provision of Service to Support the Diagnosesor Diagnoses to Support the Services Provided?
IDG based on the comprehensive assessment(s) should assist the medical director in updating which conditions are contributing to the patient’s deteriorating statusCare plan development must be based on the hospice patient’s/caregiver’s assessed needsServices must be related to the terminal condition
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Updating Diagnoses and the Plan of Care
Most hospice patients don’t get betterCondition worsensNew symptoms Exacerbation of conditionsClinical care documentation supports what was done for the patient – don’t be afraid to add diagnoses to support the further deterioration
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Palmetto GBA Hospice Top Denial ReasonsTOB 81X
Rank Denial CodeDenial Code DescriptionCount of Claims Denied
Percent of Claims Denied to total claims denied
1 5CF36 Not Hospice Appropriate 79 24.5
2 5CFNP No Plan of Care Submitted 52 16.1
3 56900Auto Denial ‐ Requested Records not Submitted 51 15.8
4 5CNOE No Valid Election Statement Submitted 41 12.7
5 5CF01General Inpatient Services Not Reasonable and Necessary _ Beneficiary Liable 29 9
5 55503 LCD Denial ‐ no medical necessity 29 9.0
6 5CFH9Physician Narrative Statement Not Present or Not Valid 11 3.4
7 5CFH6 Initial Certification Not Timely 8 2.5
8 5CFH2 No Certification Present 6 1.9
9 5CFTFFace to Face Encounter Requirements Not Met 5 1.5
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Palmetto GBA Hospice Top Denial ReasonsTOB 82X (hospital based)
RankDenial Code Denial Code Description
Count of Claims Denied
Percent of Claims Denied to total claims denied
1 5CFNP No Plan of Care Submitted 5 38.5
2 56900Auto Denial ‐ Requested Records not Submitted 2 15.4
3 5CF36 Not Hospice Appropriate 2 15.4
4 5CFH6 Initial Certification Not Timely 2 15.4
5 5CFH2 No Certification Present 1 7.7
5 5CNOE No Valid Election Statement Submitted 1 7.7
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OFFICIAL CODING GUIDELINES
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ICD‐10‐CM Official Guidelines for Coding and Reporting
CMS and the National Center for Health Statistics (NCHS) provide guidelines for coding and reporting using the International Classification of Diseases, 10th Revision, Clinical Modification (ICD‐10‐CM) Set of rules to be used along with the official conventions and instructions found within the ICD‐10‐CM (code books, encoders etc.)
Rules are approved by four organizations: American Hospital Association (AHA), the American Health Information Management Association (AHIMA), CMS, and NCHS The AHA coding clinic is the “official” coding advice. They work with NCHS and CMS to provide guidance on questions related to coding in the U.S.
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2016 ICD‐10‐CM Official Guidelines for Coding and Reporting
Located in the front of every published code book Included as part of encoder softwareFree for download at http://www.cdc.gov/nchs/icd/icd10cm.htm
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Reasons Why Claims Are RTP’d
Failure to follow Official Guidelines for Coding and Reporting Code edit for manifestation codes listed as principal Examples of manifestation codes:
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Official Guidelines Conventions
Explain that all characters must be assigned for the code to be a valid code ‐ codes may have 3‐7 characters Explain the use of placeholder character X ‐ to allow for further expansion of codes (new with ICD‐10‐CM) Explain the use of Episode of care ‐ seventh character codes (new with ICD‐10‐CM)
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Official Guidelines Conventions
Explain abbreviations, punctuation and specific terms used throughout the code book Ex: NOS, NEC, “and”, “with”, “see”, “see also”, “code also”
Provide etiology and manifestation conventions “code first”, “use additional code” and “in diseases classified elsewhere”
Explain Inclusion terms and Exclusion Notes (“Excludes 2” notes new with ICD‐10‐CM)
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Excludes 1 Notes ‐ Updated Coding Advice
“Question: We have received several questions regarding the interpretation of Excludes 1 notes in ICD‐10‐CM when the conditions are unrelated to one another. How should this be handled? Answer: If the two conditions are not related to one another, it is permissible to report both codes despite the presence of an Excludes1 note.
For example, the Excludes1 note at code range R40‐R46, states that symptoms and signs constituting part of a pattern of mental disorder (F01‐F99) cannot be assigned with the R40‐R46 codes. However, if dizziness (R42) is not a component of the mental health condition (e.g., dizziness is unrelated to bipolar disorder), then separate codes may be assigned for both dizziness and the mental health condition. In another example, code range I60‐I69 (Cerebrovascular Diseases) has an Excludes1 note for traumatic intracranial hemorrhage (S06.‐). Codes in I60‐I69 should not be used for a diagnosis of traumatic intracranial hemorrhage. However, if the patient has both a current traumatic intracranial hemorrhage and sequela from a previous stroke, then it would be appropriate to assign both a code from S06‐ and I69‐”
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NOS versus NEC Discussion
NOS = Unspecified and NEC = Other SpecifiedNEC: Senile degeneration of brain, not elsewhere classified = G31.1 = the patient’s diagnosed condition does not have a code to assignNOS: Dementia NOS = F03.90 = I don’t know
Must obtain as much information as possible, however some codes will still have NOS as part of the description ex: I11.9 = Hypertensive Heart Disease without heart failure OR Hypertensive heart disease NOS
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General Coding Guidelines
How to find a codeUse of signs and symptoms codesMultiple coding for a single conditionAcute and chronic conditionsCombination codesSequelaLaterality (new with ICD‐10)BMI, non‐pressure chronic and pressure ulcer documentationComplications of careBorderline diagnosis
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Chapter Specific Coding Guidelines
Most chapters have additional guidelines for specific diagnoses ‐ Examples:Dementia in diseases classified elsewhere Codes may never be a principal diagnosis They must be listed after the underlying condition code
HIV Patients admitted with unrelated conditions (ex: trauma), the code for the trauma must be coded first Patients admitted to treat the HIV‐related condition (ex: Pneumocystis Carinii Pneumonia), the principal diagnosis should be B20 HIV followed by the related condition
Acute MI (STEMI and NSTEMI) Unspecified MI defaults to STEMI of unspecified site I21.3 Acute defined as 28 days or less from onset
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Use ICD‐10‐CM Official Guidelines for Coding and Reporting to Make Decisions
When unsure look to guidelines and conventionsSome assumptions in relationships to other conditions may be madeHypertension and Chronic Kidney Disease I12 Hypertensive chronic kidney disease Use an additional code for the stage of chronic kidney disease (N18.5, N18.6)
Osteoporosis and Fractures M80.0‐ Osteoporosis with current pathological fracture
Atherosclerotic heart disease with angina I25.11 native artery or I25.7 bypass graft or transplanted heart
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Chapter Specific Coding Guidelines ExampleChapter 10: Diseases of the Respiratory System
Chronic Obstructive Pulmonary Disease [COPD] and Asthma1) Acute exacerbation of chronic obstructive bronchitis and asthma
“The codes in categories J44 and J45 distinguish between uncomplicated cases and those in acute exacerbation. An acute exacerbation is a worsening or a decompensation of a chronic condition. An acute exacerbation is not equivalent to an infection superimposed on a chronic condition, though an exacerbation may be triggered by an infection.”
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New Concepts in ICD ‐10‐ CM Bring New Challenges
Diabetic combination codes (type, body system affected and complications affecting the body system)Laterality Encounter of CareStatus codes for fractures
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Diabetic Combination Codes
Diabetic Type E08 Diabetes due to underlying condition E09 Due to drug/chemical E10 Type I E11 Type II E13 Other specified Diabetes
Body System Affected Kidney, ophthalmic, neurological, etc.
ComplicationsDiabetic nephropathy Proliferative diabetic neuropathy with macular edemaDiabetic neuropathy, etc.
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Laterality
Laterality concerns include misidentification of the side effected, identification of dominanceRight and left should not be coded separately if a bilateral code is present (“1” usually represents right and “2” represents right)Right and left should both be coded when a bilateral code is not present and the condition is present on both sides
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Laterality
Caution with site and “unspecified” codes L89.203 Pressure ulcer of unspecified hip, stage 3 does not mean the ulcer is unspecified or unstageable L89.219 Pressure ulcer right hip, unspecified stage L89.210 Pressure ulcer right hip, unstageable L89.893 Pressure ulcer of other site, stage 3
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Encounter of Care
Many categories have a seventh character which describes the encounter of care for the condition. This is why post acute care providers can now code fractures and injuriesGuidelines have changed during post implementationWe need to understand when to assign eachWe must not rely on the previous provider’s code assignments
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Describing the Encounter of Care
A= Initial Encounter
Acute phase
Surgical intervention
ED encounter
Initial evaluation and continuing treatment by the same or a different physician
Active treatment of the condition
D = Subsequent En
counter
Acute phase
After initial treatment
Used for routine care during healing or recovery phase
S =Sequela
Care of a residual effect or condition arising after the acute phase
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When Can Hospice Use the Seventh Character A?
Physician determines whether the patient is receiving active treatment for the condition or ongoing care for the condition Initial encounter of care may continue for certain complication and injury categories for example: Complication codes such as surgical wound infections or dehiscence Some injury codes such as puncture wounds and lacerations Burns and corrosion wounds
Not to be used with fracture codes
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Examples of Appropriate Seventh Character “A” Assignment in Hospice
Patient with deep right lower quadrant stab wound of abdomen. Treated in hospital with wound Vac®and discharged with hospice and continue wound Vac® care Assign code S31.613A Laceration without foreign body of abdominal wall right lower quadrant, with penetration into the peritoneal cavity, initial encounter
Patient discharged with hospice to manage ongoing antibiotic treatment and wound care of a dehisced surgical wound Assign T81.31xA Dehiscence of a surgical wound
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Examples of Inappropriate Seventh Character “A” Assignment in Hospice
The patient is admitted to hospice with dressing changes and care for a healing postoperative wound infection that was treated during an acute care hospitalization. The patient is no longer receiving antibiotics for the infection. What is the appropriate 7th character for the wound infection code? Assign code T81.4xxD, Infection following a procedure, subsequent encounter‐the 7th character is "D" because the patient is no longer receiving active treatment of the infection and is receiving routine care during the healing and recovery phase
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Seventh Character Status
The seventh character may also represent a statusEncounter of Care plus Status example:M80.051D, Age‐related osteoporosis with current pathological fracture, right femur, subsequent encounter with routine healing D indicates subsequent encounter with routine healing
S52.132H, Displaced fracture of neck of left radius, subsequent encounter for open fracture Type I or II with delayed healing H indicates type of fracture, subsequent encounter and delayed healing
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A – Initial encounter
D –Subsequent,
routine healing
G –Subsequent,
delayed healing
K –Subsequent, nonunion
P –Subsequent, malunion
S – Sequela
Pathological or Stress Fracture Seventh Characters
Image: © iStock Photo Beeldbewerking
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A – Initial closed
B – Initial open
D –Subsequent routine
G –Subsequent delayed
K –Subsequent nonunion
P –Subsequent malunion
S – Sequela
Acute/Traumatic FracturesFractures – Seventh Character
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Open Fractures – Seventh Character
A – Initial closedB – Initial open,
Type I or IIC – Initial open, Type IIIA, IIIB, IIIC
D–Subsequent, closed, routine
E– subsequent, open, Type I or II,
routine
F ‐ Subsequent, open, Type IIIA, IIIB, IIIC, routine
G – Subsequent, closed, delayed
H – Subsequent, open, Type I or II,
delayed
J – Subsequent, open, Type IIIA, IIIB, IIIC, delayed
K– Subsequent, closed nonunion
M – Subsequent, open, Type I or II,
nonunion
N – Subsequent, open, Type IIIA, IIB or IIIC, nonunion
P – Subsequent, closed, malunion
Q – Subsequent, open, Type I or II,
malunion
R– Subsequent, open, Type IIIA, IIB or IIIC, malunion
S – Sequela
Neoplasm Guidelines
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Unknown Primary and Secondary Neoplasm
Advanced metastatic disease with unknown primary and secondary sites has its own code C80.0 –Disseminated malignant neoplasm, unspecifiedThis should not be used due to lack of documented primary and/or secondary siteThis should be used when the physician is unable to specify the primary or secondary site
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Anemia
Anemia associated with malignancyManagement of anemia associated with malignancy – the appropriate code for the malignancy is sequenced as the principal diagnosis followed by the anemia code (D63.0)
Anemia associated with chemotherapy, immunotherapy and radiation therapy, admission for the management of the anemia Adverse effect of chemo or immunotherapy, the anemia code is sequenced first followed by the neoplasm and the adverse effect (T45.1X5) Adverse effect of the radiotherapy, code the anemia, followed by the neoplasm code and code Y84.2, Radiological procedure and radiotherapy as the cause
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Dehydration Due to Neoplasm
Guidelines indicate that when the admission is for management of dehydration due to malignancy and ONLY the dehydration is being treated (IV rehydration), the dehydration is sequenced first followed by the malignancyHospice does NOT treat only the dehydration
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Pathological Fracture due to Neoplasm
Guidelines indicate that when the focus of treatment is for the fracture a code from M84.5, Pathological fracture in neoplastic disease, should be sequenced first followed by the code for the neoplasmHospice focus of treatment and reason for the patient’s terminal condition would NOT be the fracture, the neoplasm would beThe neoplasm should be sequenced first, followed by the associated pathological fracture
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Current Malignancy Versus History
When the primary malignancy is excised but the patient continues treatment, code the primary malignancy as currentWhen the primary malignancy is excised and the patient is no longer receiving treatment of the malignancy (no evidence of the malignancy), personal history should be usedWhen coding a secondary malignancy a primary malignancy must also be coded (either current or history)
Heart Failure Guidelines
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Heart Disease
Heart disease and hypertension Should be coded separately UNLESS the physician links them ex: “due to” “with” “hypertensive” Conditions that are linked must be coded to I11.9 Hypertensive heart disease without heart failure or I11.0 Hypertensive heart disease with heart failure Use an additional code for the type of heart failure I50.‐
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Heart Disease
What if the note indicated that the patient had CHF with hypertension and chronic kidney disease? The physician linked the heart disease and hypertensionWe can assume the relationship to the chronic kidney diseaseWe would assign a combination code for Hypertensive heart and chronic kidney disease I13.‐ Use an additional code for the type of heart failure I50.‐ Use an additional code for the stage of the chronic kidney disease (N18.5, N18.6)
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Symptom Coding
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Symptoms, Signs, and Ill‐defined Conditions
Should be avoided as principal diagnosis, these are the codes from chapter 18 that begin with an “R”Should be used when a diagnosis has not been establishedShould not be used when associated with the disease process of a diagnosis already establishedMay be used in addition to a diagnosis if the symptom is not routinely associated with the diagnosis The definitive diagnosis should be sequenced first
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Coding Pain
Neoplasm Related Pain Code G89.3 Pain documented as related to the cancer Pain can be acute or chronic Coding guidelines indicate that the code may be the principal code when the reason for the admission is control of the pain, the neoplasm would be coded as an additional diagnosis In hospice part of the care is to control the pain, the reason for the admission is the terminal diagnosis
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Uncertain Diagnosis
Diagnosis documented at the time of discharge = “probable”, “suspected”, “likely”, “questionable”, “possible” or “still to be ruled out” etc.May be coded as if the condition was established ONLY for inpatient admissions to short‐term, acute long‐term care and psychiatric hospitalsHospice does not fall into this category Rather, code the condition(s) to the highest degree of certainty such as symptoms, signs, abnormal test results, or other reason for the visit If the physician documents “evidence of” a condition, it is not considered an uncertain diagnosis and should be coded in the outpatient setting
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Coding Cases
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Coding Case 1 The following documentation is from the health record of an 85‐year‐old female patient.Discharge Summary: This 85‐year‐old female patient was noted to have three to four falls in the past two months at ABC Nursing Home. Patient fell yesterday from her parked wheelchair and hit the left frontal temporal area of her head causing a contusion. For this reason, the patient was brought to the hospital for observation and further workup. The patient’s exam was remarkable for moderate ataxia. Past medical history includes senile dementia – Alzheimer’s, late onset type, depression and emphysema. Current medications include Zoloft and Theophylline. CT scan of the brain noted that the patient had multiple masses in the brain due to metastatic disease. It was felt that the patient’s ataxia was most likely due to the metastatic disease of the brain. These results were discussed with the patient’s family. After much discussion regarding the treatment options, the family decided that they did not want the patient to undergo further tests and/or evaluation. It was the family’s decision that the patient be transferred back to the nursing home and put under hospice care.
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Case 1
What is the most likely the principal diagnosis?When coding the Neoplasms which one should be listed first?Can we code the emphysema without further information?
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Case 1
C79.31 Secondary malignant neoplasm brain C80.1 Primary malignant neoplasm, unspecifiedG30.1 Alzheimer’s, late onsetF02.80 Dementia in diseases classified elsewhere
without behavioral disturbanceF32.9 Depression NOSJ43.9 Emphysema NOSS00.83XD Contusion head other specified partW05.0XXD Fall (accidental) from, off, out of,
wheelchair (OPTIONAL)
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Coding Case 2From a discharge summary written by an internal medicine physician.
The patient was admitted for dizziness and a vague feeling of epigastric discomfort. She has a history of duodenal carcinoma which was resected two years ago. The patient underwent chemo and has been in relatively good health over the last year until recently when she took a rapid decline. She no longer has evidence of an existing primary duodenal malignancy.During her hospitalization, she underwent a GI workup to evaluate her current issues. An abdominal ultrasound showed a large liver mass. Oncology was consulted. The mass was further evaluated by needle biopsy and found to be metastatic carcinoma. After lengthy consultation with me and the oncologist, the patient and family wish the patient to be a “Do Not Resuscitate” with no further workup and comfort care only. The patient was transferred from my service on the telemetry unit to the hospice program for ongoing palliative care
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Case 2
Medical Director confirms that the cancer is the primary reason for the patient’s terminal conditionWould the primary malignancy be the principal diagnosis be listed first?What else should be coded?
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Case 2
C78.7 Secondary malignant neoplasm of liverZ85.068 Personal history of small intestineZ51.5 Palliative careZ66 Do Not Resuscitate (DNR)Z90.49 Acquired absence of other parts of
digestive tractZ92.21 Personal history of antineoplastic
chemotherapy
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Coding Case 3
Patient was discharged to hospice immediately following a hospital stay for IV antibiotics for MRSA Pneumonia and a newly diagnosed pathological fracture. She also has Hypertension with Hypertensive Heart Disease and COPD with chronic obstructive bronchitis and is oxygen dependent. Patient was discharged with a new inhaler and the antibiotics were discontinued prior to hospital discharge. The H&P also included notes indicating that the patient needed supervision prior to this hospitalization due to memory loss.
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Case 3
What might be the primary reason for hospice care?From a coding perspective would Pneumonia be one of the diagnoses?Possibilities include: COPDHypertension Heart Disease Pathological fractureDementia
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Principal Diagnosis
Medical Director determines the condition which is contributing to the terminal prognosis as COPDThe patient had COPD with a lower respiratory infection however this does not mean that it is COPD with (acute) exacerbation (J44.1) And the patient no longer has a lower respiratory infection
Principal Diagnosis = J44.9 COPD (includes chronic obstructive bronchitis OR with further clarification it may be J44.0 Decompensated or Acute COPD
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Other Diagnoses?
Hypertension is not essential hypertension it should be coded to Hypertensive heart diseaseThe fracture was pathological and would require further information to identify the pathologyThe memory issues would need further information to identify type of dementia
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Other Diagnoses
M80.08XD Age related osteoporosis with current pathological fracture of vertebra(e), subsequent care w routine healing* I11.9 Hypertensive heart disease, NOS (or w/o heart failure)
*Based on a query to the physician to determine cause of pathological fracture.
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Other Diagnoses
I67.2 Cerebral atherosclerosis*F01.50 Vascular dementia, without behavioral problems*Z99.81 Oxygen dependenceZ87.01 Personal History of PneumoniaZ51.5 Palliative careZ66 Status (post), Do Not Resuscitate (DNR)
*Based on a query to the physician to determine cause of memory loss. For Vascular dementia (the underlying condition should be coded first). If diagnosis is unknown may use R41.81 Age‐related cognitive decline (Senility NOS)
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QUESTIONS
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Disclaimer
This Presentation has been prepared for informational purposes only from sources believed accurate and reliable as of the date of preparation. It is intended to inform the reader about the subject matter addressed. This is not to be used or interpreted as tax or professional advice.
Those seeking such advice should contact a Marcum professional to establish a client relationship.
